C. Helmers

Prognosis in acute stroke with special reference to some cardiac factors

Neurological assessments were done regularly during hospitalization in 283 consecutive patients (mean age 73 yr) with acute cerebrovascular disease treated at the Stroke Unit of Serafimerlasarettet. A preplanned investigation program and strict criteria for diagnosis and treatment were followed. Hospital mortality was 18%. Patients with a major cerebral infarction or haemorrhage often died very early during the hospital period and deaths due to complications increased significantly during the second week. Multivariate analysis regarding mortality showed that a low neurological score and heart failure were the most important factors for the short-term prognosis. In those patients with cerebral infarction, ambulatory capacity and ECG-diagnosed bundle branch block added significantly to the prognostic power of the neurological score. Among the 227 patients discharged alive, 1 and 2-yr mortality was 14 and 18% respectively. Here, the most important long-term prognostic factors were age and ST changes on the ECG. Again, considering only patients with cerebral infarction (N = 190), bundle branch block was found to be the single most useful predictive factor. Prognostication in acute ischemic stroke should thus be based not only on neurological findings but on careful evaluation of associated cardiac disease, especially in the long-term perspective.

Validation of admission criteria to a stroke unit

Abstract Recent and sudden onset of focal neurological deficit as criteria for admission to a stroke unit was evaluated prospectively in 2252 consecutive admissions to a medical department. According to the criteria, 169 patients were initially suspected of having an acute cerebrovascular disorder. This was later confirmed in all but 17 of them. Another 24 patients, not correctly classified initially, also turned out to have suffered a stroke. In practice, sensitivity of the criteria was, therefore, 86% and specificity 99%. Had the criteria been more strictly adhered to in the emergency ward, sensitivity could have increased to 97%, and specificity to 100%. Thus, simple criteria of this kind seem appropriate for a standardized identification of stroke in the acute situation.

Lack of effect of theophylline on the outcome of acute cerebral infarction

In patients with acute ischemic stroke, dramatic but often transient improvements have been noticed after theophylline injections. Whether better results could be obtained by continuous infusion of the drug was evaluated in a double‐blind study. Out of 46 patients with a mean age of 75 years, 22 got theophylline as aminophylline (bolus dose of 230 mg followed by 0.5 mg/kg/h) and 24 placebo during 3 days. The groups were comparable in all aspects at the outset of the trial. Serum theophylline concentrations were kept within the therapeutic range recommended for patients with asthma. No significant difference in outcome was noticed between the groups during the hospital period when repeated neurological assessments by two different scores and mortality were compared.